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Proof Surviving Legal Heirs - V03 PDF
Proof Surviving Legal Heirs - V03 PDF
(V03, 08/2017)
(d) Paternal and maternal grandparents in the absence of persons called for in items
(b), and (c) above.
_______________________ _________________________ ____________
_______________________ _________________________ ____________
_______________________ _________________________ ____________
HQP-PFF-030
(V03, 08/2017)
(e) Brothers and sisters in the absence of persons called for in items (b), (c) and (d)
above. (Use another sheet if necessary)
Name of Guardian of
Age Address
Brother/Sister Minors
1. ___________________ _______ ___________________ ______________
2. ___________________ _______ __________________ ______________
3. ___________________ _______ ___________________ ______________
(f) Children of deceased brother/s and sister/s. (State age, address and guardian of
minors). This is required only in the absence of items (b), (c) and (d) above.
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
The undersigned hereby make/s claim to the Pag-IBIG Fund provident benefits of
the deceased ___________________________ and declare, confirm, affirm and agree
that the written statements and affidavits and all other papers called for the instructions
hereon shall constitute declaration, confirmation and affirmation and they are hereby
made a part of this Proof of Surviving Legal Heirs and further declare, confirm, affirm
and agree that the furnishing of this form or any other forms supplemented thereto, to
said Pag-IBIG Fund shall not constitute nor be considered an admission by the
Pag-IBIG Fund that the deceased is entitled to the provident benefits under PD 1530
(As amended by Executive Order Nos. 527 and 538), PD 1752 (As amended by
Executive Order Nos. 35 and 90, and Republic Act No. 7742), and RA 9679; nor a
waiver of any of its right or defenses.
_______________________________ ______________________________
HQP-PFF-030
(V03, 08/2017)
ACKNOWLEDGMENT
NOTARY PUBLIC